Be aware of osteoporosis
Did you know that there is more to bones than Calcium? Yes, the aware ness of Vitamin D has opened another vista in bone health but the story of making bone (osteoblastic action) versus bone breakdown (osteoclastic action) needs to be highlighted in view of widespread osteoporosis.
Osteoporosis denotes bone loss and is usually post-menopausal or andropausal but could also be due to causes like kidney and thyroid disorders, use of certain drugs (steroids, long-term proton pump inhibitors, anti-seizure drugs) and even alcoholism. Lack of exercise (sedentary) and smoking can also precipitate it. In the breakand-make cycle of bone turnover, when the osteoclasts outdo the osteoblasts, the net peak bone density gets eroded gradually. Osteopenia is when the net bone density is less than 1 to 2.5 below normal and porosis is even beyond.
Peak bone mass begins to decrea se after 35 years of age and rapidly after menopause.
`Penic’ bone is weak and slightly less dense but `porotic’ bone is brittle and can fracture spontaneously with trivial force. The fact that estrogen and testosterone support that `blastic’ phase over the `clastic’ phase, clearly proves the hormonal cause and effect mechanism.
Normal protein, collagen and calcium, all of which give bone strength get enfeebled (not tightly woven to gi ve it density) and specially the bones of the hip, vertebrae (back), ribs and wrists are the first sufferers. Fractures can occur in the form of cracks (hip bone after a small fall) or a collapse (spine following a jerk in the vehicle).
Given this frightening scenario, we need to prevent and in fact preempt this. Accept menopause ant start supplementing calcium and top-up and maintain Vit D. Next is where today’s class kicks in, for there is more. There is a group of drugs known as anti-resorptive agents that decrease removal of calcium from the bone. Bone is a living dynamic structure being constantly built and removed and thereby performs the function of maintaining normal calcium levels in the blood. It also serves the task of repairing tiny cracks of daily wear and tear. Anti-resorpti ve drugs (bisphosphonates) inhibit removal of bone (resorption) and thus tip the bone balance in favour of increasing bone density. Whilst HRT was once the charmed treatment, besides bisphosphonates (alendronate, ibandronate etc), newer drugs like Denosumab (Prolia) also play a similar role. Thus calcium and Vit D need to be combined with them to act as the `cementer’ in formation.
There is one novel drug which is a synthetic version of the parathyroid hormone -teriparatide which actually helps `make’ (osteoblastic or anabolic) bone but it has to be injected daily into the skin and is expensive. However, treatment results are excellent.
Thus, we see that besides the pawn (calcium) and the king (vit D), there are a few `Wazirs’ which play a pivotal role in bone preservation -only your metabolic physician can guide you to move that piece.
